Moving from APap to BiPap - Things to look out for?

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Gryphon
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Re: Moving from APap to BiPap - Things to look out for?

Post by Gryphon » Fri Jan 19, 2018 8:50 am

After about 30+ min with the hybrid mask my nose started to hurt and I had to take it off and put my F10 back on. which is really annoying because I so much want to like the hybrid mask. It doesn't leak at all and has a much smaller profile on my face making it easier to sleep closer to the pillow but there's the nose thing... Maybe the other hybrid with the nose pillows would be better for me? Anyone use it? My DME doesn't stock it but maybe....

Also when I switched back to my F10 the breathing felt different on the BIPAP which was very odd... I liked how it felt better on the hybrid mask.

I worked out a bit better what the Ti min & max did. Looks like the Ti max is a measure of the time your given to breath in before the machine forces the Pressure Support change. Ti min maybe the time it takes to get to normal pressure after it detects an inhale. Also are the Ti min and max settings something that can cause significant impact on treatment or can they be viewed more as a comfort thing if you make slight changes till it feels more natural.

Please let me know if I'm wrong about that.

Not so sure how I feel about the PS of 6... it just feels really odd. I have this weekend to work on getting used to it but well have to wait and see.

I didn't have time to look at sleepy head yet but the morning overview showed an AHI of 1. So I guess that's a good thing. If the pressure changes were causing centrals I'm guessing I would have seen a higher AHI then that.

Thanks

Gryphon

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Pugsy
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Re: Moving from APap to BiPap - Things to look out for?

Post by Pugsy » Fri Jan 19, 2018 9:08 am

Gryphon wrote:are the Ti min and max settings something that can cause significant impact on treatment or can they be viewed more as a comfort thing if you make slight changes till it feels more natural.
Comfort only.
Gryphon wrote:Not so sure how I feel about the PS of 6... it just feels really odd.
It's a big jump from what you were using. It's going to feel odd until your body and brain gets used to it. If it is too "odd" you could maybe work up to the 6 they want you to have or maybe settle on 4 or 5 as a workable compromise.
Gryphon wrote:So I guess that's a good thing. If the pressure changes were causing centrals I'm guessing I would have seen a higher AHI then that.
Yeah...the AHI would be higher because if you had any/some/many centrals they would be included in that AHI.
AHI of 1...even if it were all centrals isn't a big deal. And the first night on a brand new machine with brand new and different settings I am betting some SWJ flagged events make up a good bit of that AHI.

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Re: Moving from APap to BiPap - Things to look out for?

Post by Okie bipap » Fri Jan 19, 2018 3:09 pm

Which hybrid mask are you using? I could never get either of the hybrids with nasal pillows to seal properly. I tried both masks for several nights, and finally gave up on them. I used the Amara View, which is a smaller mask for several months, until the ResMed F20 mask came out. I now use that as my primary mask, but resort back to the Amara View on occasion. I plan on taking the Amara View with me when I go into the hospital next week.

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Re: Moving from APap to BiPap - Things to look out for?

Post by Gryphon » Fri Jan 19, 2018 3:19 pm

That's it's name... The Amara view is the mask I tried last night. Not a true hybrid I guess. It's listed as a FFMask on cpap.com. sorry about the confusion.

I was looking for something that wouldn't rest on the top of my nose but I have an issue with tissue sensitivity, anything that pushes on the lower part of my nose or the nares seams to make my nose get stuffy almost instantly. That issue cleared up a little but I stated having this pain that was growing, coming from the base of my nose where it contacts the upper lip. I'm going to keep trying it at least 4 or 5 more times befor I write it off as not for me.

Was wondering if any of the true hybrids would work better but I may just settle back on my F10 and work on getting used to my new BIPAP with out changing anything else. Once the BIPAP is all worked out I can try again to find a better mask.

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Re: Moving from APap to BiPap - Things to look out for?

Post by ajack » Fri Jan 19, 2018 3:58 pm

You may find that Ti isn't for comfort, it is one of the specific treatment setting. Ti min is the minimum inhalation time. Ti max is the maximum inhalation time. You can see the typical settings here from page 21. Given you are just moving to bpap because of the high pressure, you may be ok on default settings till you have a doctor review. Have you put a sleepyhead chart up yet?
https://www.scribd.com/document/3534028 ... -Titration

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Re: Moving from APap to BiPap - Things to look out for?

Post by Pugsy » Fri Jan 19, 2018 4:42 pm

In the absence of any known lung/respiratory issues then Ti min and max is mostly a comfort thing.
If the doc isn't using the machine to accelerate ventilation because of a compromised respiratory system and working towards target volume stuff...comfort is the main job.

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Re: Moving from APap to BiPap - Things to look out for?

Post by Gryphon » Sat Jan 20, 2018 12:47 am

I have a tendency to breath very slowly - especially as I'm trying to fall asleep. It's like a form of relaxation. Used to do very long breathing exercises when I was doing music and playing instruments regularly.

So the default 2 second Ti Max while falling asleep was very annoying I've since upped it to 2.5 as I found that while testing out the system if I started to exhale before the 2.5 second Ti-Max was reached the machine changed to the lower PS pressure anyway. But when I was slow inhaling, hitting that wall and having the machine drop pressure while I was still breathing in was very distracting and would wake me up especially when I was getting close to drifting off. I'll be downloading my machine tomorrow and will be reviewing the numbers more closely. I'm encouraged by the AHI of 1 but the proof will still be in how I "Feel" more or less. If I feel like a car wreck after a long night of sleep then I'll be suspecting something is disturbing my sleep somewhere.

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Re: Moving from APap to BiPap - Things to look out for?

Post by ajack » Sat Jan 20, 2018 12:58 am

There is also a chart in the link, that has the Ti times for breath rate. But you don't want it cutting you short. If you are breathing in faster than you are breathing out, in general that's good. a 1:2 ratio is said to be desired. It's impossible to say over the forum without even a chart up, Other wise you could increase the rise time of the machine to make a quicker inspiration breath if needed.

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Re: Moving from APap to BiPap - Things to look out for?

Post by Gryphon » Sat Jan 20, 2018 1:49 am

Just encase anyone was wondering and a few people asked for the data. The break you see at the beginning is when I was using the "Amera View" mask and when it stops is when I took it off and switched to my F10. I also timed my self with a count down timer... gave my self two min and closed my eyes and relaxed and just counted my breaths. I averaged a little less then 13 per min. So upping the Ti Max given the chart I saw in your link makes a bit more sense now I included a screen shot of the chart as well. Let me know if that's what you were referencing.

https://imgur.com/a/hsQBa

I'm going to give my self more time to use the machine and gather more info. I'm not seeing anything too scary from the machine at this time. Looks like the machine did go higher then the min 20 I had before. I also counted maybe 8 more "Events" that were shorter in duration that wouldn't have been flagged by the machine. I'm not too concerned about them.

I didn't have any "Air in my Gut" problems but "Man my mouth was dry as a bone" and with the Humidifier set to 8 so I'm not sure what to do about that except maybe tape up like I used to. I don't want to damage my gums or teeth.

Overall I think the data is "un-impressive" which is good I think. The events that were flagged were far enough in that I'm fairly sure they were not SWJ but there weren't many events flagged so all good so far.

The climbing pressures during the night may coincide with REM? though I'm not 100% sure.

Sleep well

Gryphon

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Re: Moving from APap to BiPap - Things to look out for?

Post by ajack » Sat Jan 20, 2018 4:17 am

If that is a typical night, I'd be happy with that. You may need the higher median minute vent for now, or you are a tall man. The PS may come down a bit later. Talk with your doctor, it might be worth trialling PS:4, PS:3 gives a 50% reduction in breathing effort.
The Ti and the rise time is working for you, your insp time and I:E ratio is good. You could increase the min epap to tidy up some flow rates.

Even with a FFM, if you mouth breathe, it can get dry. Some nights are worse than others. What happens is that you don't lose treatment pressure.

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Re: Moving from APap to BiPap - Things to look out for?

Post by Pugsy » Sat Jan 20, 2018 7:19 am

Gryphon wrote:The climbing pressures during the night may coincide with REM?
That would be the logical assumption especially if your OSA is a bit worse in REM. Those time frames where it climbs do correlate when it we normally have more more REM.

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Re: Moving from APap to BiPap - Things to look out for?

Post by Gryphon » Sat Jan 20, 2018 1:30 pm

Here was last night's data... lot more "Centrals" then I'm used to seeing to be honest. Numbers overall are not "BAD" but would be nice to get them better.

Let me know if you'd like to see a close up of any of the events or if there is anything else I can show to help with "INFO"

I'm thinking I try a slightly lower PS maybe?

Doc may have prescribed a PS of 6 but that was from 1 hour / 15 min of REM so if I can get my numbers even better I'm sure as the saying goes no one's going to object.

https://imgur.com/a/djkVz

Thanks

Gryphon

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Re: Moving from APap to BiPap - Things to look out for?

Post by Gryphon » Sun Jan 21, 2018 1:29 pm

https://imgur.com/a/484KI

First 4 hours are me trying the Amara view mask again. Still wakes me up later hurting my nose so I switched it out for my F10 for the remainder of the night/morning.

Still more centrals then I'd like but overall not too bad right?

I bumped the PS to 5 but it doesn't look like it made much difference.

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Re: Moving from APap to BiPap - Things to look out for?

Post by Pugsy » Sun Jan 21, 2018 1:43 pm

Not enough centrals to worry about even if they were all the real deal and I am not so sure that we can't maybe explain a few of those centrals away as SWJ.

The people that I saw who had centrals caused by PS being too high (or just because of PS) were seeing high numbers of centrals...like 10 or more per hour every hour all night long. Yours aren't anywhere near that and aren't really clustered. I doubt that your centrals are related to PS at all.

From a comfort perspective though...I would still be tempted to try PS of 4
I have played with those PS numbers...up to 6 and from a comfort perspective there was a marked difference for me.
I just liked PS of 4 the best and found that what I felt the best with equaled better sleep and better sleep for me was my ultimate goal.
Plus I am comfortable messing with things and I have no known lung issues.
Now that I am using the AirSense 10 instead of the real bilevel..I have to be happy with PS/EPR of 3 and I am and it didn't take much getting used to for me to be happy with it.

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Re: Moving from APap to BiPap - Things to look out for?

Post by Gryphon » Fri Feb 02, 2018 5:22 pm

I finally broke down and said bugger to the initial PS of 6 and changed it to 3... numbers dropped significantly. Also has been very comfortable to fall asleep with the lower PS.

Last night I slept for almost 6 hours and only had 1 machine marked central apnea and no other events... and the duration of the Central is very close to when my second alarm clock went off so it's very likely it's just SWJ. Average AHI with PS of 3 is under 1. With the PS of 6 and 5 my AHI was averaging around 2.5 to 3 so I think that's an improvement. I'm going to call the Dr's office so they don't get too annoyed with me and explain my numbers.

I have noticed some interesting breathing patterns as well. The duration averages around 3 to 4 min. I'll see a bump in flow rate... that very slowly tapers for the whole diration then I'll see a spike in breathing again. Most of the night appears to be more even. It's interesting looking at the flow rate and finding patterns in it.